mometasone inhaled (Rx)

Brand and Other Names:Asmanex Twisthaler, Asmanex HFA
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for inhalation (Asmanex Twisthaler)

  • 110mcg/actuation
  • 220mcg/actuation

metered dose inhaler (Asmanex HFA)

  • 50mcg/actuation
  • 100mcg/actuation
  • 200mcg/actuation

Asthma

Indicated for maintenance treatment of asthma as prophylactic therapy

Asmanex Twisthaler

  • Received bronchodilators alone or inhaled corticosteroids: 220 mcg PO inhaled once daily in evening; may increase to 220 mcg q12hr if needed
  • Received PO corticosteroids: 440 mcg PO inhaled q12hr; not to exceed 880 mcg/day

Asmanex HFA

  • 2 inhalations PO q12hr (ie, 200-400 mcg q12hr); starting dose based on prior asthma therapy

  • Patients who are not on an inhaled corticosteroid: 200 mcg inhaled PO q12hr (as 2 actuations of 100 mcg/actuation)

  • Currently taking oral corticosteroids: 400 mcg inhaled PO q12hr (as 2 actuations of 200 mcg/actuation)

  • Failure to respond to initial dose after 2 weeks: Increasing dose may provide additional asthma control; maximum daily recommended dose is 200 mcg inhaled q12hr (as 2 actuations of 200 mcg/actuation); not to exceed 800 mcg/day

  • Maximum benefit may not be achieved for ≥1 week after beginning treatment; patients may experience a variable time to onset and degree of symptom relief

Dosing Considerations

Limitation of use

  • Not indicated for relief of acute bronchospasm

Dosage Forms & Strengths

powder for inhalation (Asmanex Twisthaler)

  • 110mcg/actuation
  • 220mcg/actuation

metered dose inhaler (Asmanex HFA)

  • 50mcg/actuation
  • 100mcg/actuation
  • 200mcg/actuation

Asthma

Indicated for maintenance treatment of asthma as prophylactic therapy

Asmanex Twisthaler

  • <4 years: Safety and efficacy not established
  • 4-11 years: 110 mcg PO inhaled once daily in evening; not to exceed 110 mcg/day
  • ≥12 years
    • Received bronchodilators alone or inhaled corticosteroids): 220 mcg PO inhaled once daily in evening; may increase to 220 mcg q12hr if needed

    • Received PO corticosteroids: 440 mcg PO inhaled q12hr; not to exceed 880 mcg/day

Asmanex HFA

  • <5 years: Safety and efficacy not established
  • 5 to <12 years: 100 mcg inhaled PO q12hr (as 2 actuations of 50 mcg/inhalation); not to exceed 200 mcg/day
  • ≥12 years
    • 2 inhalations PO q12hr (ie, 200-400 mcg q12hr); starting dose based on prior asthma therapy
    • Patients who are not on an inhaled corticosteroid: 200 mcg inhaled PO q12hr (as 2 actuations of 100 mcg/actuation)
    • Currently taking oral corticosteroids: 400 mcg inhaled PO q12hr (as 2 actuations of 200 mcg/actuation)
    • Failure to respond to initial dose after 2 weeks: Increasing dose may provide additional asthma control; maximum daily recommended dose is 200 mcg inhaled q12hr (as 2 actuations of 200 mcg/actuation); not to exceed 800 mcg/day
    • Maximum benefit may not be achieved for ≥1 week after beginning treatment; patients may experience a variable time to onset and degree of symptom relief

Dosing Considerations

Not indicated for relief of acute bronchospasm

Asmanex Twisthaler: Not indicated in children <4 years

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Interactions

Interaction Checker

and mometasone inhaled

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    No Interactions Found
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      Serious - Use Alternative

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              Serious - Use Alternative (3)

              • aldesleukin

                mometasone inhaled decreases effects of aldesleukin by Other (see comment). Avoid or Use Alternate Drug. Comment: Corticosteroids may interfere with antitumor effects of aldesleukin.

              • desmopressin

                mometasone inhaled increases toxicity of desmopressin by Other (see comment). Avoid or Use Alternate Drug. Comment: Corticosteroids may enhance the hyponatremic effect of intranasal desmopressin.

              • loxapine inhaled

                mometasone inhaled increases toxicity of loxapine inhaled by Other (see comment). Avoid or Use Alternate Drug. Comment: Agents used to treat airway disease may enhance the toxic effect of inhaled loxapine.

              Monitor Closely (36)

              • amphotericin B deoxycholate

                mometasone inhaled increases toxicity of amphotericin B deoxycholate by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may enhance the hypokalemic effect of amphtericin B. .

              • atazanavir

                atazanavir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of Cushing's syndrome or adrenal suppression.

              • bumetanide

                mometasone inhaled increases toxicity of bumetanide by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.

              • ceritinib

                mometasone inhaled increases toxicity of ceritinib by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypoglycemic effects of ceritinib.

              • chlorothiazide

                mometasone inhaled increases toxicity of chlorothiazide by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.

              • chlorthalidone

                mometasone inhaled increases toxicity of chlorthalidone by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.

              • ciprofloxacin

                mometasone inhaled and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • clarithromycin

                clarithromycin will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases riak for systemic corticosteroid side effects

              • cobicistat

                cobicistat will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases risk for systemic corticosteroid side effects

              • corticorelin

                mometasone inhaled decreases effects of corticorelin by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may blunt plasma ACTH response to corticorelin.

              • darunavir

                darunavir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of Cushing's syndrome or adrenal suppression.

              • deferasirox

                mometasone inhaled increases toxicity of deferasirox by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids increase risk of gastrointestinal ulceration/irritation.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases riak for systemic corticosteroid side effects

              • ethacrynic acid

                mometasone inhaled increases toxicity of ethacrynic acid by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.

              • fosamprenavir

                fosamprenavir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of Cushing's syndrome or adrenal suppression.

              • furosemide

                mometasone inhaled increases toxicity of furosemide by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.

              • gemifloxacin

                mometasone inhaled and gemifloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • hyaluronidase

                mometasone inhaled decreases effects of hyaluronidase by Other (see comment). Modify Therapy/Monitor Closely. Comment: Corticosteroids may decrease therapeutic effects of hyaluronidase.

              • hydrochlorothiazide

                mometasone inhaled increases toxicity of hydrochlorothiazide by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.

              • indinavir

                indinavir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of Cushing's syndrome or adrenal suppression.

              • itraconazole

                itraconazole will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases risk for systemic corticosteroid side effects

              • ketoconazole

                ketoconazole will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases riak for systemic corticosteroid side effects

              • letermovir

                letermovir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • levofloxacin

                mometasone inhaled and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • levoketoconazole

                levoketoconazole will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases riak for systemic corticosteroid side effects

              • lopinavir

                lopinavir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of Cushing's syndrome or adrenal suppression.

              • moxifloxacin

                mometasone inhaled and moxifloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • nefazodone

                nefazodone will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases riak for systemic corticosteroid side effects

              • nelfinavir

                nelfinavir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of Cushing's syndrome or adrenal suppression.

              • nirmatrelvir

                nirmatrelvir will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration may increase certain systemic corticosteroid concentrations. Increased risk for Cushing syndrome and adrenal suppression. Consider alternant corticosteroids, including beclomethasone and prednisolone).

              • nirmatrelvir/ritonavir

                nirmatrelvir/ritonavir will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration may increase certain systemic corticosteroid concentrations. Increased risk for Cushing syndrome and adrenal suppression. Consider alternant corticosteroids, including beclomethasone and prednisolone).

              • ofloxacin

                mometasone inhaled and ofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • ribociclib

                ribociclib will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ritonavir

                ritonavir increases levels of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of Cushing's syndrome or adrenal suppression.

              • saquinavir

                saquinavir will increase the level or effect of mometasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increases riak for systemic corticosteroid side effects

              • torsemide

                mometasone inhaled increases toxicity of torsemide by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.

              Minor (0)

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                Adverse Effects

                >10%

                Headache (26%)

                Viral infection (14%)

                Pharyngitis (12%)

                Epistaxis (11%)

                1-10%

                Cough (7%)

                Upper respiratory tract infection (6%)

                Dysmenorrhea (5%)

                Frequency Not Defined

                Loss of taste

                Muscle soreness

                Vision blurred

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                Warnings

                Contraindications

                Hypersensitivity

                Immunosuppressed patients

                Tuberculosis

                Status asthmaticus or other acute asthma episode necessitating intensive measures

                Known hypersensitivity to milk proteins or any other ingredients

                Cautions

                Respiratory tract tuberculosis, untreated fungal or bacterial infections, viral or parasitic infections, ocular herpes simplex

                Nasal septum perforation, epistaxis, wheezing

                Cataracts, glaucoma, increased intraocular pressure reported; consider referral to an ophthalmologist in patients who develop ocular symptoms or long term therapy

                Risk of more serious or fatal course of chickenpox and measles in susceptible individuals; avoid use in unvaccinated or immunologically unexposed children or adults

                Deaths from adrenal insufficiency have occurred after abrupt withdrawal of oral steroids; taper withdrawal gradually

                May retard growth in children

                Immunocompromised patients

                Excessive use may suppress hypothalamic-pituitary-adrenal function

                During periods of stress or severe status asthmaticus, patient may require supplementary systemic corticosteroids immediately; carry warning card to that effect

                Long-term administration reduces bone mineral density

                Fungal infections

                • Localized infections of the mouth and pharynx with Candida albicans reported; if oropharyngeal candidiasis develops, treat with appropriate local or systemic (i.e., oral) antifungal therapy while remaining on treatment; at times therapy may need to be interrupted
                • To reduce risk of oropharyngeal candidiasis, after dosing, advise patients to rinse their mouth with water and spit out the contents without swallowing

                Drug interaction overview

                • Strong CYP3A4 inhibitors (eg, ritonavir): Use with caution; may cause increased systemic corticosteroid effects
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                Pregnancy & Lactation

                Pregnancy

                There are no randomized clinical studies in pregnant women

                Animal data

                • In animal reproduction studies with pregnant mice, rats, or rabbits, mometasone furoate caused increased fetal malformations and decreased fetal survival and growth following administration of doses that produced exposures ~1/3 to 8 times the maximum recommended human dose (MRHD) on a mcg/m2 or AUC basis
                • However, experience with oral corticosteroids suggests that rodents are more prone to teratogenic effects from corticosteroid exposure than humans

                Clinical considerations

                • In women with poorly or moderately controlled asthma, there is an increased risk of several perinatal adverse outcomes such as preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate
                • Closely monitor pregnant women with asthma and adjust medication as necessary to maintain optimal asthma control

                Lactation

                There are no available data on the presence in human milk, the effects on the breastfed child, or the effects on milk production

                Other inhaled corticosteroids, similar to mometasone furoate, are present in human milk

                Consider developmental and health benefits of breastfeeding along with the mother’s clinical need and any potential adverse effects on the breastfed infant from mometasone inhaled or from the underlying maternal condition

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Corticosteroid with potent anti-inflammatory properties; exerts effects on various cells, including mast cells and eosinophils; also exerts effects on inflammatory mediators (eg, histamine, eicosanoids, leukotrienes, cytokines)

                Absorption

                Minimally absorbed

                Onset: 1-3 days

                Bioavailability: <0.1%

                Distribution

                Protein bound: 98-99%

                Metabolism

                Metabolized in liver by CYP3A4

                Elimination

                Half-life: 5.8 hr

                Excretion: Urine, bile

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                Administration

                Oral Inhalation Administration

                Twisthaler

                • Hold the inhaler straight up (upright position) with the colored portion (the base) on the bottom; remove cap of Twisthaler while it is in this upright position to make sure that you get the right amount of medicine with each dose
                • Breathe out fully
                • Place the mouthpiece in mouth, holding it in a horizontal (on its side) position; firmly close lips around mouthpiece and inhale dose
                • Remove from your mouth and hold your breath for about 10 seconds, or as long as you comfortably can; do not breathe out into the inhaler

                HFA inhaler

                • Oral inhalation only
                • After each dose, rinse their mouth with water and, without swallowing, spit out the contents to help reduce the risk of oropharyngeal candidiasis
                • Remove cap from the mouthpiece of the actuator before use
                • Prime before using for the first time by releasing 4 test sprays into the air, away from the face, shaking well before each spray
                • In cases where the inhaler has not been used for more than 5 days, prime inhaler again by releasing 4 test sprays into the air, away from the face, shaking well before each spray
                • Do not use the mometasone HFA actuator with any other inhalation drug product.
                • Do not use actuators from other products with the Asmanex HFA canister

                Storage

                Twisthaler

                • Store in a dry place at 25ºC (77ºF); excursion between 15-30ºC (59-89ºF)

                HFA inhaler

                • Store at room temperature 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
                • Keep out of reach of children
                • Do not use or store near heat or open flame; exposure to temperatures <120ºF may cause bursting; never throw container into fire or incinerator
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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % cream
                mometasone topical
                -
                0.1 % cream
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % solution
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % cream
                mometasone topical
                -
                0.1 % cream
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % solution
                mometasone topical
                -
                0.1 % solution
                mometasone topical
                -
                0.1 % solution
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % ointment
                mometasone topical
                -
                0.1 % cream
                mometasone topical
                -
                0.1 % cream
                Asmanex HFA inhalation
                -
                100 mcg/actuation aerosol
                Asmanex HFA inhalation
                -
                200 mcg/actuation aerosol
                Asmanex HFA inhalation
                -
                50 mcg/actuation aerosol
                Sinuva sinus
                -
                1,350 mcg implant
                Asmanex Twisthaler inhalation
                -
                220 mcg/ actuation (14) aerosol
                Asmanex Twisthaler inhalation
                -
                220 mcg/ actuation (120) aerosol
                Asmanex Twisthaler inhalation
                -
                220 mcg/ actuation (60) aerosol
                Asmanex Twisthaler inhalation
                -
                110 mcg/ actuation (30) aerosol
                Asmanex Twisthaler inhalation
                -
                220 mcg/ actuation (30) aerosol
                mometasone nasal
                -
                50 mcg/actuation aerosol
                mometasone nasal
                -
                50 mcg/actuation aerosol
                mometasone nasal
                -
                50 mcg/actuation aerosol

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

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                Patient Education
                mometasone topical

                MOMETASONE - TOPICAL

                (mow-MET-uh-sown)

                COMMON BRAND NAME(S): Elocon

                USES: This medication is used to treat skin conditions such as eczema, psoriasis, allergies, and rash. Mometasone decreases swelling (inflammation), itching, and redness. Mometasone is a medium-strength corticosteroid. This medication is available in several forms including cream, ointment, and lotion (solution). Your doctor will choose the type of product based on the skin condition/area of the body being treated.

                HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using this medication and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is for use only on certain areas of skin: do not use it on the face, groin, or underarms, or for diaper rash, unless directed to do so by your doctor.Wash and dry your hands before using. Clean and dry the affected area. Apply as directed by your doctor, usually a thin film of medication to the affected area once daily. Gently rub in. Do not cover the treated area with bandages or other dressings unless instructed to do so by your doctor.Do not wash or rinse the medication off immediately after applying it. Wash your hands with soap and water after each use unless you are using this medication to treat the hands. Avoid getting this medication in your eyes, nose, or mouth. If this occurs, rinse thoroughly with water and call your doctor if irritation lasts.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time each day. Do not apply large amounts of this medication, use it more often, or use it for longer than prescribed. Your condition will not improve any faster, and your risk of side effects may increase.Tell your doctor if your condition does not improve after 2 weeks of treatment or if it worsens.

                SIDE EFFECTS: Burning, itching, or stinging may occur when you apply this medication, but usually only lasts a short time. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: stretch marks, skin thinning/discoloration, acne, hair bumps (folliculitis).Rarely, it is possible this medication will be absorbed from the skin into the bloodstream. This can lead to side effects of too much corticosteroid. These side effects are more likely in children, and in people who use this medication for a long time or over large areas of the skin. Tell your doctor right away if any of the following side effects occur: unusual/extreme tiredness, weight loss, headache, swelling ankles/feet, increased thirst/urination, vision problems.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before using mometasone, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: poor blood circulation, diabetes, immune system problems.Corticosteroids can make skin infections worse and more difficult to treat. Tell your doctor if you have a skin infection so it can be treated. Tell your doctor promptly if your condition does not improve or if you have worsening skin symptoms.Rarely, using corticosteroid medications for a long time or over large areas of skin can make it more difficult for your body to respond to physical stress. Before having surgery or emergency treatment, or if you get a serious illness/injury, tell your doctor or dentist that you are using this medication or have used this medication within the past few months.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Though it is unlikely, this medication may temporarily slow down a child's growth if used for a long time. See the doctor regularly so your child's height can be checked.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

                OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for other skin problems unless told to do so by your doctor. A different medication may be necessary in those cases.Laboratory and/or medical tests (such as adrenal gland function tests) may be performed periodically to monitor your progress or check for side effects, especially if you use this drug for an extended period of time or apply it over large areas of the body. Consult your doctor for more details.

                MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

                STORAGE: Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                Information last revised January 2022. Copyright(c) 2022 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.